The present invention relates to computer-implemented interactive training techniques for treating depression. More specifically, the present invention relates to intensive computer-implemented behavioral training techniques that effectively remediate symptoms of clinical depression and of depressive personality disorders.
Depression in its manifold specific forms is the most common form of diagnosed mental illness. Although the symptoms may vary in different individuals, a common distinction between depressives differentiates `unipolar` from `bipolar` individuals. The former have a single-polar (depressed) disorder of mood. The latter swing alternatively (commonly with a cycle period of days to weeks in duration) between depression and mania. Within these simple distinctions and under the broad umbrella term `depression` fall many depression subtypes and an overlapping classification of an often-milder `depressive personality`.
There are many thousands of published reports on the epidemiology, neurology, and treatment of this commonly occurring illness, and many thousands more publications relate to the study of its underlying neurology. Generally speaking, there are two primary treatment strategies that have been effective for very large populations of depressives. These two primary treatment strategies involve phamacological therapies and psychological therapies. Generally speaking, there are three primary treatment strategies that have been effective for large populations of depressives. These three treatments are pharmacotherapy, psychotherapy, and electro-convulsive therapy.
The pharmacological treatment of depression most commonly involves application of a drug that partially blocks the extracellular-to-intracellular re-uptake of the brain transmitter serotonin, thereby increasing available serotonin levels at its normal extra-cellular site of action. Equally effective anti-depressive effects have been observed when the re-uptake of the brain transmitter norepinephrine is partially blocked. Both actions are believed to increase the active quantities of these neurotransmitters in synaptic zones, which are their main sites of effect, which in turn appears to alleviate the symptoms of depression.
It is believed that anti-depressive medications can also result in the elaboration of the cortical terminals of norepinephrine-containing neurons that have their cell bodies within the locus coeruleus, the small brainstem nucleus that contains all of the NE cells that project to the cerebral cortex. It is noted that those cortical terminals tend to be more sparse in animal models of depression. Neuron numbers in this nucleus also tend to be smaller in number in depressed patients who commit suicide. On the other hand, neurons in this nucleus and their terminal arbors in the cortex have been shown to be capable of being physically regeneratively invigorated and elaborated by drug treatment that results in the more normal reengagement of this critical modulatory control system.
It is noted, however, that while drug treatment `overcomes` depression, there are commonly underlying residual behavioral differences between depressives and normals that are not impacted by the pharmacological treatment. For example, in a standard index of depression symptoms, abnormal responses to danger and willingness to make a novel choice are two measures of depression. As another example, with treatment with fluoxetine (Prozac), the former measure (which is likely more directly related to serotonin level imbalance and drug-induced correction) is improved, while the latter measure (which is likely more directly related to norepinephrine level imbalances) is not.
As mentioned earlier, psychological therapies represent an important form of treatment for depressives. Psychotherapy and related widely applied therapies (e.g., meditation training) plausibly have their primary impacts through quieting and calming the patient, i.e., in relieving underlying chronic and episodic impacts of stress, which is believed to be a contributor to depression. In the past, psychotherapies typically involve weekly hour long sessions with a therapist that focus on one of three strategies: behavioral changes, cognitive changes, or social changes in the patient. These weekly sessions last three to four months, after which the patient improvement may be comparable to pharmacotherapy. Each of the psychotherapies focuses on discussing changes that the patient is expected to self-implement for the rest of the week. For instance, one type of behavioral psychotherapy has the patient itemize things associated with harm and things associated with reward. The patient is then instructed to seek out things that are rewarding while minimizing exposure to things that evoke fear responses. The goal is for the patient to have some control over his environment.
Electroconvulsive treatment is generally found effective in older subjects who do not respond well to pharmacotherapies. A series of electrical `shocks` are delivered to the temples of the subjects in each session, and subjects, with a high probability, begin to feel better after several weekly sessions. It should also be noted that a substantial subpopulation of depressed patients are resistant to any or all of the pharmacological, psychotherapeutic, and electroconvulsive treatments, and that persistence of symptoms and relapse are common.
In view of the foregoing, there are desired therapeutic techniques that can remediate depression or prevent its onset without introducing unwanted side effects. In particular, there are desired depression treatments, prophylactic or otherwise, that do not require or that reduce the need for anti-depressive medication or psychotherapy.